Ethical Framework: 7 Principles
Regional health district officials in a rural area of New York noticed over the past decade that many elderly members of the community were being admitted to the hospital for conditions that were largely preventable or that could have been addressed more appropriately, and at less cost, in outpatient clinics if they had been seen by the medical staff earlier. In order to understand how to meet the health care needs of this group of elderly people, and possibly to reduce costs, the NY regional health district agreed to enter into a research partnership with the local university.
The aim was to use surveys to investigate traditional and existing health care practices, health- related beliefs, and the health needs of the district’s elderly population. Researchers obtained IRB approval from the local hospitals to access participants’ hospital records. The study focused on people in the rural community who were at least 70 years old, a majority of whom lived with a family member or healthcare provider who acted as the subjects’ medical legal guardian. Participants, and when appropriate medical legal guardians, were informed about the study and its purpose. The researchers obtained verbal consent from each participant. The interviews were conducted in a separate room at the participants’ home and lasted between 60 and 90 minutes. To ensure privacy and confidentiality, no family members were in the room with the researcher and participant.
Midway through one of the interviews with an 80-year-old man, the investigators noticed that the participant had started to tremble and sweat, and had become incoherent. The researcher called the participant’s son who reacted angrily, and accused the investigators of being insensitive and callous. He shouted that the researcher had intentionally made his father sick in order to force him into the hospital where he would be over-medicated, instead of being cared for at home by his family. He demanded that the researcher to leave his home immediately.
Discuss some of the specific ethical concerns that should be considered while doing research on the elderly? How do you define “elderly” – is it based on age, cognitive ability, etc.? What ethical framework could be adopted to take into consideration cognitive impairment or an underlying medical condition in consenting elderly patients for research? How would you assess the patients’ decisional capacity?
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